Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Study shows for first time decrease in mortality associated with physician order entry system

03.05.2010
Researchers at Lucile Packard Children's Hospital and Stanford University School of Medicine have shown for the first time that a significant decrease in hospital-wide mortality rates can be associated with implementation of a computerized physician order entry system.

The system, launched at Packard Children's in 2007, was correlated with a 20 percent decrease in mortality rates at the hospital over an 18-month period, according to a new study to be published online May 3 in Pediatrics. Researchers noted that other patient care initiatives at the hospital may also have contributed to this important change.

With CPOE, doctors and other medical staff can prescribe medications, tests and other treatments electronically, making the instructions instantly and remotely available to all authorized hospital staff, even when off-site. CPOE is part of the hospital's electronic medical record, which also provides on screen the latest images and test results. All physicians need to do is boot up a computer, punch in a password and the heartbeat of a child in the neonatal intensive care unit will trace across the screen, or a brain scan can be viewed.

The study arrives as a debate rages over the benefits of CPOE and electronic medical records. While many proponents, including the Obama administration, see these new technologies as critical to improving the quality of our health-care system, critics contend their value has yet to be proven, particularly as some past research has shown negative consequences, including one site that witnessed an increase in mortality.

"Prior to our report, no hospital or medical institution has shown that CPOE can be implemented and actually have an associated decline in mortality," said lead author Christopher Longhurst, MD, medical director of clinical informatics at Packard Children's and assistant clinical professor of pediatrics at Stanford. "But what we found is that CPOE implementation was statistically correlated with fewer patient deaths. As you can imagine, this is very meaningful." Longhurst was part of a team of eight researchers from Packard Children's, Stanford and Harvard University involved in the study.

Mark Del Beccaro, MD, a pediatrics professor and vice chair for clinical affairs at Seattle Children's Hospital, who was not involved in this study, said he welcomed the new findings. Seattle Children's Hospital implemented CPOE in 2003. "Three years later a study of the effects showed mortality rates at our institution held steady," Del Beccaro said. "As the evolution and maturity of these systems and their benefits are being realized, there has been soft evidence that they improve patient safety. The Packard Children's report is the first I am aware of to show that you can potentially affect mortality by putting CPOE in place. This is an important study, and we hope others can realize these benefits."

Longhurst emphasized that the new results show a correlation, not a cause and effect. "Our implementation of CPOE was executed superbly, but in addition, we were simultaneously making other advances in patient care," he said. "These included process and workflow changes, adjustments in ICU staffing, the rollout of Rapid Response Teams, the implementation of a nursing residency and more, all in the face of rising acuity in the hospital."

To determine if a change in mortality rates occurred, Longhurst and his colleagues reviewed nearly 100,000 discharges from Packard Children's from Jan. 1, 2001, through April 30, 2009. They compared the observed mortality with the expected mortality, which was generated from a database of 42 tertiary-care, not-for-profit pediatric hospitals similar to Packard Children's.

The result of their analysis was a finding of two fewer deaths per 1,000 discharges at Packard Children's in the period after CPOE was implemented, a total of 36 lives over 18 months.

There are many ways CPOE can have a lifesaving impact. With CPOE, crucial data and suggestions that can help guide clinical decisions pop up on the screen as the doctor types in orders and other information about the patient. There will be, for instance, a friendly electronic nudge if a dosing calculation appears to be in error. And it can improve efficiency. "We've seen a 20 percent improvement in the time from order to administration for 'stat' [immediate] medications," noted Longhurst. "This can have lifesaving consequences."

Still, it's important to remember that CPOE, and electronic medical records in general, are simply technology tools that support or "hard-wire" best practices into the work environment. "Simply purchasing a fancy and expensive electronic medical records system in and of itself is not likely to make much of a positive impact on quality or patient safety," said Paul Sharek, MD, MPH, medical director of quality management and chief clinical patient safety officer at Packard Children's. "What provides the real opportunities for improving care is using this technology to support best practice, such as displaying relevant blood test results at the time physicians are ordering medications, or allowing practice guidelines to be immediately available to physicians at the time of order entry." Sharek, who is an assistant professor of pediatrics at the medical school, is the study's senior author.

Longhurst concluded: "We believe our experience is proof that CPOE is here to stay. However, to be successful, it takes an unwavering commitment to implementation. Our staff was very supportive, seeing it as a critical part of a hospital-wide commitment to continuous improvement in patient care. This approach gave us a better chance to determine if CPOE really has an impact in a hospital setting."

Other Stanford/Packard Children's authors on the study are Christopher Dawes, MBA, the hospital's president and chief executive officer; Jill Sullivan, RN, MSN, vice president of hospital transformation; Christy Sandborg, MD, professor of pediatric rheumatology and the hospital's chief of staff; Jin Hahn, MD, professor of pediatric neurology; and Eric Widen, MHA, administrative director of performance improvement at the hospital.

The Stanford University School of Medicine consistently ranks among the nation's top medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://mednews.stanford.edu. The medical school is part of Stanford Medicine, which includes Stanford Hospital & Clinics and Lucile Packard Children's Hospital. For information about all three, please visit http://stanfordmedicine.org/about/news.html.

Ranked as one of the best pediatric hospitals in the nation by U.S.News & World Report, Lucile Packard Children's Hospital at Stanford is a 312-bed hospital devoted to the care of children and expectant mothers. Providing pediatric and obstetric medical and surgical services and associated with the Stanford University School of Medicine, Packard Children's offers patients locally, regionally and nationally the full range of health-care programs and services — from preventive and routine care to the diagnosis and treatment of serious illness and injury. For more information, visit http://www.lpch.org

Robert Dicks | EurekAlert!
Further information:
http://www.lpch.org

More articles from Studies and Analyses:

nachricht The personality factor: How to foster the sharing of research data
06.09.2017 | ZBW – Leibniz-Informationszentrum Wirtschaft

nachricht Europe’s Demographic Future. Where the Regions Are Heading after a Decade of Crises
10.08.2017 | Berlin-Institut für Bevölkerung und Entwicklung

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: The pyrenoid is a carbon-fixing liquid droplet

Plants and algae use the enzyme Rubisco to fix carbon dioxide, removing it from the atmosphere and converting it into biomass. Algae have figured out a way to increase the efficiency of carbon fixation. They gather most of their Rubisco into a ball-shaped microcompartment called the pyrenoid, which they flood with a high local concentration of carbon dioxide. A team of scientists at Princeton University, the Carnegie Institution for Science, Stanford University and the Max Plank Institute of Biochemistry have unravelled the mysteries of how the pyrenoid is assembled. These insights can help to engineer crops that remove more carbon dioxide from the atmosphere while producing more food.

A warming planet

Im Focus: Highly precise wiring in the Cerebral Cortex

Our brains house extremely complex neuronal circuits, whose detailed structures are still largely unknown. This is especially true for the so-called cerebral cortex of mammals, where among other things vision, thoughts or spatial orientation are being computed. Here the rules by which nerve cells are connected to each other are only partly understood. A team of scientists around Moritz Helmstaedter at the Frankfiurt Max Planck Institute for Brain Research and Helene Schmidt (Humboldt University in Berlin) have now discovered a surprisingly precise nerve cell connectivity pattern in the part of the cerebral cortex that is responsible for orienting the individual animal or human in space.

The researchers report online in Nature (Schmidt et al., 2017. Axonal synapse sorting in medial entorhinal cortex, DOI: 10.1038/nature24005) that synapses in...

Im Focus: Tiny lasers from a gallery of whispers

New technique promises tunable laser devices

Whispering gallery mode (WGM) resonators are used to make tiny micro-lasers, sensors, switches, routers and other devices. These tiny structures rely on a...

Im Focus: Ultrafast snapshots of relaxing electrons in solids

Using ultrafast flashes of laser and x-ray radiation, scientists at the Max Planck Institute of Quantum Optics (Garching, Germany) took snapshots of the briefest electron motion inside a solid material to date. The electron motion lasted only 750 billionths of the billionth of a second before it fainted, setting a new record of human capability to capture ultrafast processes inside solids!

When x-rays shine onto solid materials or large molecules, an electron is pushed away from its original place near the nucleus of the atom, leaving a hole...

Im Focus: Quantum Sensors Decipher Magnetic Ordering in a New Semiconducting Material

For the first time, physicists have successfully imaged spiral magnetic ordering in a multiferroic material. These materials are considered highly promising candidates for future data storage media. The researchers were able to prove their findings using unique quantum sensors that were developed at Basel University and that can analyze electromagnetic fields on the nanometer scale. The results – obtained by scientists from the University of Basel’s Department of Physics, the Swiss Nanoscience Institute, the University of Montpellier and several laboratories from University Paris-Saclay – were recently published in the journal Nature.

Multiferroics are materials that simultaneously react to electric and magnetic fields. These two properties are rarely found together, and their combined...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

“Lasers in Composites Symposium” in Aachen – from Science to Application

19.09.2017 | Event News

I-ESA 2018 – Call for Papers

12.09.2017 | Event News

EMBO at Basel Life, a new conference on current and emerging life science research

06.09.2017 | Event News

 
Latest News

Rainbow colors reveal cell history: Uncovering β-cell heterogeneity

22.09.2017 | Life Sciences

Penn first in world to treat patient with new radiation technology

22.09.2017 | Medical Engineering

Calculating quietness

22.09.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>